Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine. The disease may cause severe abdominal pain and nutritional problems (food intolerance and deficiencies). The major types of IBD are Crohn's disease (CD) and ulcerative colitis (UC). CD and UC mainly differ by their location and nature of the inflammatory changes. CD can affect any part of the gastrointestinal tract, from the oral cavity to the anus, with more common clinical manifestations occurring in the ileum and large intestine. UC is restricted to the colon and the rectum.
The etiology of IBD is still not completely understood, but increasing evidence suggests that these disorders occur through an inappropriate immune response to a subset of commensal enteric bacteria in a genetically susceptible host, with disease initiated by environmental triggers. In this regard, sustained intestinal infections, mucosal barrier defects, mucosal immune dysregulation, and genetic and environmental factors all seem to contribute to the disease process.
It is presently unclear how nutritional intake is connected to the disease.
Thus, dietary habits are considered to be a very important environment factor. It is therefore speculated that some nutritional intake may be responsible for inducing, avoiding or potentially treating the disease. Mixtures of prebiotics and probiotics have been used to treat the disease. Beattie et al (1994; Aliment. Pharmacol. Ther.; 8: 1-6) have reported the use of the acid casein fraction in an infant formula in the treatment of 7 children with active small bowel Crohn's disease. U.S. Pat. No. 5,952,295 describes the use of a casein fraction rich in TGF-beta2 for the treatment or prophylaxis of inflammatory conditions of the gastro-intestinal tract, in particular IBD.
Presently, anti-inflammatory drugs, like corticosteroid drugs or mesalazine, antibiotics and, in very severe cases surgery are the preferred choices for treating IBD. While in some cases the above described drugs can already induce clinical remission and reduce intestinal symptoms of IBD, an acute resurgence/relapse of the symptoms can appear following treatment. For example, in children, Crohn's disease has a chronic relapsing course in which up to 50% of the patients eventually need surgery (Davies, G et al; 1990; Br. J. Surg.; 77: 81-94).
The natural clinical course of inflammatory bowel disease (IBD) is characterized by episodes of relapse and remission. The main treatment goal in IBD is to induce and maintain remission by effective control of the gut inflammatory process. Despite the existence of treatments for induction of remission of the disease, the assessment of the level of resolution of the inflammatory process at the intestinal level remains uncertain in the current clinical practice. Subclinical inflammation and incomplete mucosal healing may still persist at the end of a therapeutic cycle that otherwise can be considered successful from a clinical point of view. An “incomplete” biological remission of the inflammatory process is supposed to represent a higher risk for earlier relapse.
In recent years, the gut microbiome has gained increasing attention for its potential role in inflammatory bowel disease (IBD) pathogenesis by triggering abnormal local mucosal inflammatory processes. In fact, Escherichia coli has been shown to stimulate the release of proinflammatory cytokines, whereas other bacterial species such as Lactobacillus casei and L. plantarum downregulate the expression of pro inflammatory cytokines and prevent mucosal damage. Administration of prebiotics, such as oligosaccharides and probiotics (live non-pathogenic bacteria) in animals and healthy human subjects has proven effective for altering the gut microbiome, suggesting that these strategies may be useful in IBD. Despite the general acceptance of the gut microbiota playing a role in IBD etiology and promising preclinical results, probiotic administration has thus far been unsuccessful for maintaining remission or preventing clinical and endoscopic relapse in CD. Disappointing results have also been obtained in randomized controlled trials of prebiotics in CD. In the present application there is provided a nutritional composition that assists in the prevention or postponement of relapse.